For decades, the health sector has struggled with the recurring disruption of medical services caused by damage to hospitals in the aftermath of natural disasters. Just when these services are most needed, they are either unavailable or must be provided in makeshift quarters because a health facility cannot function. In the worst case scenario, collapsed health facilities have claimed the lives of patients and health staff, as was the case with Juarez Hospital in Mexico during the earthquake of 1985. This tragedy pointed to the incongruence of investing in preparing the health workforce to deal with disasters without first ensuring that they will survive the impact or that the facilities in which they work can remain operational. In the decades that followed, meetings were organized, resolutions adopted, guidelines published and professionals trained. But more than 20 years later, we are still lacking the strong political commitment and sufficient financial resources needed to ensure that hospitals and health facilities are indeed able to continue functioning when disasters strike.

A new opportunity will soon be launched that is expected to go a long way toward raising awareness of this issue and bolstering the much-needed political backing to effect change. The International Strategy for Disaster Reduction (ISDR) has adopted hospitals safe from disasters as the theme for the upcoming 2008-2009 World Disaster Reduction Campaign. Organized within the context of the Hyogo Framework for Action (HFA), and adopted at the 2005 World Conference on Disaster Reduction, this campaign will take up one of the HFA calls to action, specifically: “integrating disaster risk reduction planning into the health sector and promoting safe hospitals.” The World Health Organization is the ISDR’s main partner.

Meeting the goal of having hospitals safe from disasters—an ambitious, long-term undertaking—requires political commitment, a commitment that is not apparent unless a well-informed public and/or the mass media demand a call to action. The World Disaster Reduction Campaign aims to generate this commitment and garner support for increasing the resilience of health facilities and services in disaster situations. Improving resilience implies improving the structural resilience of health facilities (new or existing) so as to avoid their collapse or total loss; guaranteeing that non-structural elements (such as water heaters, storage tanks, mechanical equipment, shelving, cabinets, lifelines, etc.) do not compromise the security of patients or the delivery of services, and finally, ensuring that the health workforce is well prepared to respond to the challenges generated by the disaster. To achieve overall resilience, multiple disciplines must be involved: from managers to engineers and architects; from emergency room physicians to the primary health care providers.

A Goal that Requires Political Commitment


Meeting the goal of having hospitals safe from disasters—an ambitious, long-term undertaking—requires political commitment, a commitment that is not apparent unless a well-informed public and/or the mass media demand a call to action.

For a number of years, PAHO/WHO member countries have talked about “safe hospitals” in the context of their ability to remain functional in disaster situations. However, the term also generated some confusion. Safety, in terms of a hospital’s systems and its physical premises, was sometimes confused with patient safety, which is also a serious issue in health care. Clearly, the structural or functional safety of a hospital is directly linked to patient safety: preventing a building’s collapse or simply avoiding the necessity of a dangerous evacuation in emergency conditions saves lives and protects patients from harm. However, patient safety is a much broader topic than hospitals safe from disasters, which is the specialized focus of the World Disaster Reduction Campaign. Maintaining this specialized focus should not be interpreted as failing to appreciate the magnitude of issues of patient safety—medical errors, negligence, or improper care. However, this Campaign will spotlight the need to improve the disaster-resilience of the health facilities and health services through investments in structural and non-structural measures and the involvement of the health workforce in community disaster risk reduction. Hospitals safe from disasters is often a forgotten or neglected issue at the political level. Diverting attention from this focus may mean that we fail to muster the political support needed to strengthen the resilience of health facilities to natural disasters.

Risk Reduction in the Health Sector: a Collective Responsibility

Some people may believe that protecting hospitals from natural disasters is the responsibility of the disaster program in the Ministry of Health. Nothing could be further from the truth, and, in fact, PAHO/WHO has recently stepped up efforts to strengthen its overall corporate capacity to deal collectively with this issue. The challenge of the forthcoming Campaign is to involve as many disciplines, institutions, and partners as possible in achieving its objectives. For example, a communicable disease control program might look at its physical assets, such as laboratories, to see how vulnerable they are to disasters. Disaster risk should become a concern and a responsibility of the experts in patient safety, much in the same way that disaster managers should address ways to reduce medical errors or improve quality control in post-disaster emergency care. Primary health care providers are best equipped to assume the challenge of incorporating risk reduction into health initiatives at the community level.
In short, all health actors must join forces to direct the spotlight on the issue of hospitals safe from disasters in order to secure the political and public support needed to achieve this goal—a goal that has still not been met despite PAHO/WHO’s efforts in hospital disaster mitigation over the last two decades.